Antiepileptic drugs (AEDs) are the mainstay of treatment for epilepsy, but seizures continue in one-third of patients despite appropriate AED therapeutic trials.

Even in the current era, the etiology of epilepsy often remains unclear.

Some patients with unexplained partial seizures which are medication resistant may have “autoimmune epilepsy” — epilepsy characterized by autoimmune antibodies.

Although autoimmune epilepsy is still rare, it’s become an increasingly recognized cause of epilepsy, which might have been previously thought to be of unknown cause.

What is the immune system and what are the types of immune disorders?

Your immune system protects the body from the bad guys —infections and foreign substances that invade the body and cause disease.

White blood cells, or leukocytes, are on the prowl throughout the body in blood vessels and monitor for viruses, bacteria, or foreign substances that may cause a problem.

Antibodies are proteins produced by the immune system and attack infections or foreign substances.

In contrast, autoimmune disorders are groups of diseases which invade the immune system and attack the body’s healthy organs and tissues, as if they were foreign invaders.

What are the features of autoimmune epilepsy?

Autoimmune epilepsy is actually a group of invaders, and compromises the immune system to cause recurrent seizures, difficulty in thinking, emotions, or other brain functions.

What tests can be done to support autoimmune epilepsy?

First, other causes of epilepsy must be ruled out.

People should be evaluated for underlying brain infections such as encephalitis, meningitis, or abscess.

Blood and urine tests may detect genetic or metabolic conditions.

Auto-antibodies can also be detected by a lumbar puncture— a safe procedure where a needle is inserted into your lower back to draw out the cerebrospinal fluid which bathes the brain and surrounds the spinal cord in the back.

What are the treatments for autoimmune epilepsy?

In addition to using antiepileptic medications to control seizures, immunotherapy is used to treat autoimmune epilepsy.

Intravenous immunoglobulin (IVIG) which can block and remove damaging auto-antibodies is simply a blood product of pooled antibodies collected from healthy volunteers.

IVIG or high doses intravenous steroids are given repeatedly, usually every week for about six weeks.

If there is a good result, then the time interval between IVIG or intravenous steroids is gradually increased (every other week followed by every three weeks).

Another option is plasma exchange if IVIG treatment and intravenous steroids are not helpful.

Plasma exchange draw the “bad” blood — filters and removes the harmful auto-antibodies and then returns.

However, Dr. P. Ian Andrews of Duke University said in an interview that he felt this blood-cleansing technique only provided a temporary solution because the body soon begins to generate antibodies again.

But he said it might find limited use in arresting severe, degenerating cases so that patients would have some temporary relief and doctors would get a chance to try alternative medications and treatments.

“The body should not make antibodies that eat up its own brain but, knowing this happens, it should point to other strategies for treatment,” Dr. Andrews said, “Perhaps we can find a way to selectively remove the bad antibody or develop a substance to block its activity.”

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